IF YOU WANT TO HEAR GOD LAUGH, TELL HIM OF YOUR PLANS.

A sad reminder that we only have today came with the sudden death of Hawaii physician, dedicated politician, long-time Hawaii Medical Association member and all-round good guy, Duke Bainum. Duke served on the Honolulu County Council and narrowly lost the recent election for Honolulu mayor. A ruptured or leaking aneurysm may give symptoms, but too often the break comes abruptly and surgical intervention and survival may be limited to hours if not minutes. He was taken by ambulance to Queen’s Medical Center and died within two hours of arrival. At age fifty-six Duke should have had many good years of life, love and service in his future. He is already sorely missed.

MORALITY CANNOT BE LEGISLATED BUT BEHAVIOR CAN BE REGULATED.

The often moralistic administration posture of the George W. Bush White House has been altered by the current power structure in Washington. The controversial Bush rule that reinforced protection for health care workers who object to providing abortion-related services or even information, is soon to be rescinded. When the administration pushed the rule through in August 2008, the medical community strongly objected fearing that the mandate could endanger both access and funding for care. Additionally, a federal judge has ordered the Food and Drug Administration (FDA) to allow sales of plan B morning-after contraceptive to women age 17 and older without a prescription, overriding the age limit imposed by the Bush administration. On the marijuana side, the Obama Justice Department has decided that the issue is one of states’ rights and will not use the power of the federal judiciary to challenge the dozen or so states which permit the medical use of cannabis.

THE FUTURE AIN’T WHAT IT USED TO BE.

Sixteen years ago Hillary Clinton, the then new president’s appointee to prepare a national health plan, came to the American Medical Association House of Delegates and delivered a speech which was all sugar and spice. She promised that doctors would be free, patients would be cared for and protected, malpractice cost would be controlled, etc. She received generous applause and was graciously received. She failed in her task, largely because she refused to include established powers in her plans. At this June AMA meeting, President Obama offered no sugar and spice (it was more S & M), and cited the flood of problems in delivering health care and the unmanageable costs, and asked the AMA to participate in helping to restructure how medicine is practiced in America. He received boos from the audience when he said, "I want to be honest with you. I am not advocating for a cap on malpractice awards." He could have left the subject alone since a Democratic Congress and administration are firmly in bed with the trial attorneys, as is known by all. No reason to bring a dead cat to the party. In his speech he referred to the writing of Atul Gawande, M.D. in the New Yorker magazine, which comes very near to advocating for a Kaiser-like system of medical care. It is certain that rationing of medical care is in the future, and it will probably be wearing Henry J’s hospital pajamas.

CLEOPATRA’S MAID WAS HARD OF HEARING WHEN SHE CALLED FOR AN ASPIRIN.

Experts from around the world met recently in Melbourne, Australia, to report on snake bite deaths and injuries. At least 100,000 fatalities occur each year with another 250,000 permanently disabled, and tragically a large portion of these are children and young adults in developing nations. The American Association of Poison Control Centers recorded 6,550 snake bites in 2007 and over half were venomous. The real number is far greater since many snake bites are not recorded, and the actual figure is estimated to be in the tens of thousands. Experts agreed that snake bite kits are useless, suction devices remove a mere 1 to 2 % of injected venom and tourniquets are of limited value. The important point is that bite victims should try to be calm, minimize activity, immobilize the bitten extremity below the level of the heart, and make a rapid trip to a hospital where anti-venom should be available.

LISTEN TO THE PATIENT. SHE’S TRYING TO TELL YOU THE DIAGNOSIS.

A 44 year old woman became weak and developed back pain while at work. She went to South Broward Hospital emergency department when her fever spiked to 106 deg., and told the nurse she thought she had a kidney stone since she had stones in the past. The nurse did not write that diagnosis in the chart, nor did the ER physician. The ER doc, a 30 year ER veteran, found the patient acutely ill, and called her attending physician describing the dire condition and possible kidney stone diagnosis. The emergency physician did not treat the patient nor hand-off at shift change, expecting the patient’s physician to arrive promptly and initiate care. The treating physician, who never saw the patient and gave orders by phone, claims he received no message of crisis, and did not realize the patient was in septic shock. He decided the patient had acute cholecystitis and she underwent unnecessary surgery which further weakened her condition. Sixteen hours after arriving at the hospital, a test revealed the kidney stone which was the origin of her sepsis. It was removed. Sadly, to keep her alive surgeons had to remove both arms below the elbow and both legs below the knee. When the three month malpractice trial ended, the jury could not find anyone at fault. In an extremely rare event, Broward County Circuit Judge Charles Greene reversed the verdict! It was "contrary to the law and the manifest weight of the evidence." A new trial will be set (unless a settlement is reached).

NOTHING IS SO BORING AS HAVING TO MAINTAIN A DECEPTION.

Wow! There’s nothing nowhere like leading a research team at a major medical University for keeping your wallet in good shape. Dr. Jeffrey Wang, chief of spine surgery at UCLA medical school, was paid a substantial salary of $400,000 base pay and $375,000 for treating patients totaling $775,000 last year, which would supply an adequate living for most American families. Dr. Wang checked "no" on a UCLA disclosure form asking if he received $500 or more from Medtronic, which at the time was funding Dr. Wang’s study of a company spinal-repair system. Apparently Dr. Wang mis-remembered that between 2004 and 2007 three companies, Medtronic, DePuy unit of Johnson and Johnson and EzioMed Inc., had rewarded Dr. Wang with $459,500 for speaking and consulting fees as well as royalties on products he helped develop. In January 2007, Medtronic paid Dr. Wang $14,600 for lecture and teachings at a spine meeting in Korea for one week while the company was funding his study of their spinal-repair system.

IN PRIMITIVE SOCIETY, WHEN NATIVES BEAT THE GROUND WITH STICKS AND YELL, IT IS CALLED WITCHCRAFT; IN CIVILIZED SOCIETY IT IS CALLED GOLF.

The Rose Center for Health and Sport Science conducted a study on energy consumption in playing golf. Director Neil Wolkodoff (Walk-it-off?) found that walking 18 holes and carrying your clubs burned off 1442 calories while four hours seated at the computer burned only 517 calories. Riding in a cart is less healthy than walking and consumes only 822 calories. Additional bonus to walkers carrying clubs is that on average they score six strokes better than those who ride and four strokes better than those who rely on a caddy. Still, it is important to note that those who carry clubs or pull carts are often more physically fit. What a neat and concise solution – carry your clubs, and watch your waistline and handicap improve.

NO MATTER THE ADVERTISING, YOU CAN’T MAKE CHICKEN SALAD OUT OF CHICKEN CACA.

After receiving a letter from the National Consumers League, the Food and Drug Administration (FDA) decided to do something about the labeling on the box of Cheerios cereal. The statement "clinically proven to help lower cholesterol" makes Cheerios a drug under federal law. The FDA stated that such claims can be made for drugs only, and that to be in compliance General Mills must desist or file a new drug application. Moreover, the FDA took issue with the website which discussed the benefit of whole grains in reducing the risk of cancer and heart disease. Tom Forsythe, spokesman for Cheerios, stated that the quote came from a study where Cheerios was included in a diet low in saturated fat and cholesterol, and that it had been on the box for two years. Meanwhile the misleading Cheerios television ads continue.

ADDENDA –

------ Emergency medical personnel recommend performing CPR chest compressions in time to "Stayin’ Alive" rhythm at 103/minute, almost precisely the same as the ideal rate of 100.
----- Thanks to multiple casino security cameras, the heart attack survival rate is 53% in Las Vegas while in Chicago the survival rate is 2%.
----- According to the New York Times, 17% of tattooed Americans regret being inked.
----- A poll taken in 1997 revealed that the face from "tales from the crypt" was the most frightening on TV. Number two was Geraldo Rivera.

Aloha, and keep the faith. ----------rts

Contents of this Newsletter do not necessarily reflect the opinion, policy or position of the Hawaii Ophthalmology Society or the Hawaii Medical Association. Editorial comment is strictly that of the writer